New York Disability Nonprofit to Repay $363,000 due to Medicaid Fraud

New York’s state Medicaid system is designed to provide health care-related services to some of New York’s most vulnerable populations. One such population is people with developmental disabilities. The Office for People with Developmental Disabilities is tasked with coordinating services either directly or through a network of Medicaid-funded nonprofits. Over 700 nonprofits currently exist in New York to serve those with developmental disabilities, and these 700 nonprofits provide approximately 80% of all services.

Developmental disabilities include intellectual disabilities, cerebral palsy, Down syndrome, autism, and other disabilities. This vulnerable population relies on Medicaid-funded services, which include long-term care services, habilitation, clinical services, residential support and services, residential schools, institutions, and developmental centers. In addition, the Office for People with Developmental Disabilities provides support to families to educate them on and assist them with caring for loved ones who have developmental disabilities.

While many individuals with developmental disabilities have a strong family support system to help care for them and provide much-needed services, many individuals also rely on the care and services of non-profits funded by Medicaid under the Office for People with Developmental Disabilities. One such nonprofit is Fishkill-based Keli House Community Services.

Keli House strives to provide services to people with developmental disabilities and their families in order to decrease institutionalization rates. These services include assessing the person’s needs and then connecting them with invaluable programs. Despite its noble goal, Keli House was accused by the New York State Office of the Attorney General with violating its mission and violating Medicaid restrictions by hiring unqualified employees.

As an aside, in order to maximize the help it can provide these vulnerable residents and their families, the Office for People with Developmental Disabilities has put in place strict rules that govern all of the 700 nonprofits that provide services under its umbrella using Medicaid funds. One such rule is that all individuals who are employed by the nonprofit in coordinating services for the population must meet strict qualification standards regarding education and experience. The Office requires that each coordinator have at least an associate’s degree in health or human services and either one year of experience working with persons with developmental disabilities or one year of experience with service coordination. Finally, all service coordinators must complete a rigorous training program that has been vetted by the Office.

In violation of the rule, Keli House employed 10 service coordinators, 9 of whom were unqualified. While some of the coordinators had absolutely no prior experience, others held degrees in unrelated fields. The Medicaid Fraud Control Unit, in conjunction with the Justice Center for the Protection of Persons with Special Needs, conducted the investigation into Keli House. In response to the allegations, Keli House agreed to settle for $363,643.

While Medicaid fraud is one such way that individuals with developmental disabilities are targeted, a more direct form of harm is through caretaker abuse. Persons with developmental disabilities are especially vulnerable to abuse because many of them are unable to comprehend or understand the situation. In addition, many of them are powerless to fight against the abuse. Abuse may occur in institutionalized settings or even in special education classes or in the home. Common signs of abuse include withdrawn or antisocial behavior, depression, fear, unexplained anger, avoidance behaviors, regression, signs of physical trauma such as bruises, and any inappropriate behavior or conversations between the patient and their caretaker.

Unfortunately, abuse is rampant in the developmental disability community, and it is imperative to catch the abuse early to stop it. Report any suspected abuse or Medicaid fraud to the Office for People with Developmental Disabilities. Then call the experienced caretaker abuse lawyers at Gallivan & Gallivan today to discuss your potential claim.